Case 286 -- 21 y/o male with back pain and wobbly gait

Contributed by David Krisky, M.D., Ph.D., J. Thomas Molina, M.D., Ph.D., and Clayton Wiley, M.D., Ph.D.
Published online in November 2001

PATIENT HISTORY:

This patient was a 21 year old man with a three week history of back pain who presented emergently due to the development of thoracic myelopathy, decreased sensation at the T8 level, and wobbly gait. Initial treatment with Decadron resulted in significant improvement of symptoms, however, the patient still suffered from a wobbly gait as well as decreased proprioceptive sensation in the lower extremities bilaterally. A MRI was performed that revealed an extradural thoracic lesion.

MRI of extradural thoracic lesion
T2 weighted MRI
    MRI of extradural thoracic lesion
T2 weighted MRI

A T4-T7 laminectomy was performed with removal of the extradural lesion.

GROSS DESCRIPTION:

The specimen consisted of multiple fragments of yellow tan soft tissue measuring 4.3 x 1.6 x 1.3 cm in aggregate. Sectioning this tissue revealed a homogenous yellow tan surface without irregularity or hemorrhage.

MICROSCOPIC DESCRIPTION:

H&E
H&E
H&E
H&E
H&E
H&E
H&E
H&E
CD3
CD3
L26
L26 (CD20)
CD15
CD15
CD68
CD68
MPO
MPO
CD43
CD43
CD34
CD34
TDT
TDT

Hematoxylin and eosin stained histologic sections demonstrated a highly cellular lesion (low power H&E) composed of a monomorphic population of large polygonal cells with large nuclei, irregular chromatin, and variable prominent nucleoli admixed with a few neutrophils, histiocytes, and lymphocytes. Also within this tissue were occasional lymphocytic aggregates (higher power H&E).

Immunohistochemical staining for CD3 showed scattered positive cells, L26 (CD20) staining showed a few positive cells, staining for epithelial membrane antigen was negative (not shown), CD30 was negative (not shown), CD138 was negative (not shown), myeloperoxidase was strongly positive in most cells, CD43 staining was strongly and diffusely positive, CD15 staining was diffusely positive, while CD34 and CD68 demonstrated scattered positivity

[ PROCEED TO FINAL DIAGNOSIS AND DISCUSSION ]


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